The European mesothelioma epidemic

Our plain-English summary of The European mesothelioma epidemic, by J. Peto, A. Decarli, C. La Vecchia, et al (British Journal of Cancer, 1999).

The study

• Authors: J. Peto, A. Decarli, C. La Vecchia, F. Levi, E. Negri
• Journal: British Journal of Cancer
• Published: 1999;79(3-4):666-72
• Cited by: 691 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Projections for the period 1995-2029 suggest that the number of men dying from mesothelioma in Western Europe each year will almost double over the next 20 years, from 5000 in 1998 to about 9000 around 2018, and then decline, with a total of about a quarter of a million deaths over the next 35 years. The highest risk will be suffered by men born around 1945-50, of whom about 1 in 150 will die of mesothelioma. Asbestos use in Western Europe remained high until 1980, and substantial quantities are still used in several European countries. These projections are based on the fit of a simple age and birth cohort model to male pleural cancer mortality from 1970 to 1989 for six countries (Britain, France, Germany, Italy, The Netherlands and Switzerland) which together account for three-quarters of the population of Western Europe. The model was tested by comparing observed and predicted numbers of deaths for the period 1990-94. The ratio of mesothelioma to recorded pleural cancer mortality has been 1.6:1 in Britain but was assumed to be 1:1 in other countries.

In plain English

This study used national death statistics to project future mesothelioma deaths among men in Western Europe. Because most countries had no death code for mesothelioma, the authors analysed male death rates from pleural cancer in Britain, France, Germany, Italy, The Netherlands, Switzerland and Hungary, using World Health Organization data from 1970 onward. Rates rose in all seven countries, from +68% in Italy to +264% in Britain. A model based on age and birth year, fitted to 1970-89 data, predicted 9686 deaths in men aged 45-84 from 1990 to the latest available year; 9672 were observed. For most countries the model predicted a peak in 2015-19, and 190 000 pleural cancer deaths in the six Western European countries from 1995 to 2029. Converting to mesothelioma, the authors estimated about 250 000 male deaths in Western Europe over the next 30-35 years, rising from about 5000 a year in 1998 to about 9000 in 2018, with about 1 in 150 men born around 1945-50 dying of the disease. The authors noted that pleural cancer is an imperfect stand-in for mesothelioma and that the conversion outside Britain is uncertain.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of national death statistics using an age and birth-cohort statistical model, with projections of future deaths to 2029
• Who was studied: Men aged 40-84 in Britain, France, Germany, Italy, The Netherlands and Switzerland (about three-quarters of Western Europe's population), plus Hungary, from WHO and national death data for 1970 to 1992-94 depending on country. Hungary was excluded from the future projections.
• Exposure: Individual asbestos exposure was not measured. Recorded pleural cancer deaths (ICD 163) were used as a stand-in for mesothelioma, which the authors describe as mostly caused by asbestos.
• Main results:
  • Male age-standardized pleural cancer death rates rose in all seven countries between 1970-74 and 1990-94, from +68% in Italy to +264% in Britain.
  • Predicted lifetime probability of dying from pleural cancer for men born in 1945: 0.58% France, 0.31% Germany, 0.35% Italy, 1.39% The Netherlands, 0.44% Switzerland, 0.69% Britain, 0.10% Hungary.
  • Test of the model: in men aged 45-84 since 1990, observed pleural cancer deaths across all countries were 9672, against 9686 predicted from the 1970-89 data.
  • At age 40-44 since 1990 (men in the 1950 birth cohort), observed deaths were 199 against 211 predicted overall. Hungary was the exception, with 14 observed against 5.4 predicted (P less than 0.01).
  • Predicted annual male pleural cancer deaths at the peak (2015-19 for most countries): about 1750 Britain, 1550 France, 1370 Germany, 940 Italy, 930 The Netherlands, 160 Switzerland.
  • Predicted total male pleural cancer deaths in the six Western European countries, 1995-2029: 190 000.
  • The ratio of male mesothelioma to recorded pleural cancer deaths was about 1.6:1 in Britain and appeared to be at least 1:1 in France. Assuming 1:1 for all countries other than Britain gave 220 000 male mesothelioma deaths in the six countries between 1995 and 2029.
  • Estimated male mesothelioma deaths in all of Western Europe: about 250 000 over the next 30-35 years.
  • Annual male mesothelioma deaths in Western Europe were estimated to almost double, from about 5000 in 1998 to about 9000 in 2018.
  • About 1 in 150 Western European men born around 1945-50 were estimated to die of mesothelioma. The authors stated that the risk in the highest-risk occupational groups, notably building and engineering workers, must be very much higher.
• The authors' conclusion: The authors concluded that, given the consistent age-cohort pattern in each country, their prediction that annual pleural cancer deaths in Western Europe will more than double between 1990-94 and 2015-19 is reasonably reliable.
• Limitations the authors state:
  • Pleural cancer is an unsatisfactory stand-in for mesothelioma. It includes many lung cancer deaths and misses mesotheliomas not described as pleural on the death certificate.
  • Satisfactory data on the ratio of mesothelioma to pleural cancer exist only for Britain. The French surveys were too small, so the ratio in France and other countries may be close to 1:1 or considerably higher.
  • Projections based on past trends may be exaggerated, perhaps severely, by increasing diagnostic awareness of mesothelioma.
  • The assumption for men born around 1955 was arbitrary, and men born later were excluded, so mortality after about 2020 depends on unknown risks.
  • Long-term predictions assume that past age patterns will persist. The large reduction in asbestos use around 1980 may change this.
  • No reliable projection was possible for Hungary because of the small number of deaths in the 1950 birth cohort.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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• An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia — Y.I. Baris, A.A. Sahin, et al. (1978)
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